Provider Demographics
NPI:1790031789
Name:IRIS MART CORPORATION
Entity Type:Organization
Organization Name:IRIS MART CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL INSTRUCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:347-297-1880
Mailing Address - Street 1:40 MEMORIAL HWY
Mailing Address - Street 2:APT 14S
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-8312
Mailing Address - Country:US
Mailing Address - Phone:347-297-1880
Mailing Address - Fax:
Practice Address - Street 1:40 MEMORIAL HWY
Practice Address - Street 2:APT 14S
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-8312
Practice Address - Country:US
Practice Address - Phone:347-297-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074729170252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency